Peripheral nerve function in HIV infection - Clinical, electrophysiologic,and laboratory findings

Objective: To determine the effects of immunodeficiency, nutritional status , and concurrent systemic disease on peripheral nerve function in acquired immunodeficiency syndrome. Design: Survey of subjects infected with human immunodeficiency virus (HIV) , recruited as part of a prospective study of neuromuscular complications o f HIV infection. Setting: A neuro-acquired immunodeficiency syndrome outpatient clinic in a university medical center. Patients: A consecutive sample of 251 HIV-infected individuals. primary car e providers referred subjects to the study for evaluation of neurologic sym ptoms or for prospective neurologic assessment. Main Outcome Measures: Standardized history and neurologic examination, lab oratory tests (complete blood cell count, serum albumin level, vitamin B-12 level, and T-lymphocyte subsets),and electrophysiologic testing of sural, tibial, and ulnar nerves. Results: The most frequent neurologic diagnosis was distal symmetrical poly neuropathy (DSP) (38%). The most common clinical features were nonpainful p aresthesias (71%), abnormalities of pain and temperature perception (71%), and reduced or absent ankle reflexes (66%). Patients with DSP were signific antly older (P = .009), and had lower CD4 lymphocyte cell counts (P =. 004) and lower hemoglobin levels (P = .004) than those without DSP. Deteriorati on of values on nerve conduction studies, irrespective of the clinical diag nosis of DSP, was significantly correlated with low CD4 counts, aging, abno rmal serum albumin and hemoglobin levels, and weight loss. Most of these fa ctors co-correlated, and, with the exception of age, no single variable sig nificantly accounted for changes in results of nerve conduction studies whe n the influence of other factors was eliminated Conclusion: The combination of several factors, including age, immunosuppre ssion, nutritional status, and chronic disease, contributes to distal perip heral nerve dysfunction in HIV infection.